Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
OAC OIEM LAM SANG VA XET NGHIEM
BENH VIEM TUY CAP TAI BENH VIEN OAI HOC Y HAI PHONG
Do Thi Tinh', Le Van Thieu^ Vu Thi Hong Van' TOM TAT
Muc tieu: Mo ta trieu chu'ng lam sang va xet nghiem benh viem tuy cap tai benh vien Dai hoc Y Hai Phong. Doi tu'dng va phu'dng phap: nghien ciTu mo ta Ket qua: nghien ciTu 76 benh nhan viem tuy cap, chiing toi thay: Lam sang: 90,78% benh nhan vao vien vi ly do dau bung, 73,68% benh nhan co dau d vi trf thu'dng vi, 22,36% co non, 94,73% benh nhan co bung chudng hdi. Xet nghiem: Amylase: trong ngay dau nhap vien amylase mau tang ^ 660u/l co 6 72,36% benh nhan, trong nUdc tieu tang > 1320u/l co d 82,89% benh nhan sau do giam dan, vao ngay thir 6 chi con 3 benh nhan (3,94%) tang amylase mau, 13 benh nhan (17,10%) tang amylase nieu. Sieu am tuy:
CO 67,10% benh nhan co ton thUOng tuy tren sieu am trong do chii yeu la tuy to (42,10%), nhu mo tuy khong deu (60,52%). Bach cau > 16g/i co 32.89%.
' Sinh hoa mau: glucose mau tang >7.8mmol/l co 19 BN chiem 25%, LDH > 350u/l co 23 BN chiem 44,24%, : Triglycerit > 1.3mmol/l co 17 BN chiem 24,29%. Kit . luan: Phan Idn benh nhan viem tuy cap co bieu hien
; lam sang dau bung va non, xet nghiem co amylase mau va nieu tang cao, sieu am thu'dng co ton thu'dng tuy.
ABSTRACT
THE CHARACTERS OF THE CLINICS AND LABOLATORIES OF ACUTE PACREATITIS AT HAI
PHONG MEDICAL UNIVERSITY HOSPITAL
* Objectives: Describe the clinical and laborator/
' patient with acute pancreatitis at Hai Phong Medical University hospital. Subjects and Methods: study i descriptions Results: 76 studies of acute pancreatitis
^ patients, we found: Clinical: 90.78% of patients in / hospital because of abdominal pain, 73.68% of
•, patients had pain in the upper position, 22.36% had
vomiting, 94.73% of patients with abdominal bloating.
Labolatories: Amylase: in the first days of hospitalization blood amylase > 660u in 72.36%
patients, in increasing urine > 1320u/l in 82.89%
patients and then gradually decrease, on day 6 only 3 patients (3.94%), increased blood amylase, 13 patients (17.10%) increased urinary amylase.
Ultrasound pancreatitis: 67.10% of patients with pancreatic lesions on ultrasound in pancreatic mainly to (42.10%), pancreatic tissue is irregular (60.52%).
WBC > 16g with 32.89%. Biochemical blood: blood glucose > 7.8mmol with 19 patients accounted for 25%, LDH > 350U/I with 23 patients accounted for 44.24%, Triglycerit > 1.3mmol with 17 patients accounted for 24.29%. Conclusions: Most patients with acute pancreatitis are clinical manifestations of abdominal pain and vomiting, blood tests and urine amylase is high, ultrasound can damage the pancreas.
I. OAT V A N o f
Viem tuy cip (VTC) la benh ph6 biln tren thi giai cQng nhu a Viet Nam. La benh cdp cuu vh bung thuong gap. Nguyen nhan ciia viem tuy cap dimg dau la rugu (35%) va soi mat (dac biet la soi tui mat, 38%), cac nguyen nhan khac ft gap hon, [1] [6]. T6n thucmg ciia tuy bi viem cap thay doi, tir phii ne dhn hoai tir hay hoai tir xuat huyet. Viem tuy cap thi nang co thi din den tir vong. Vai su tiln bo ciia khoa hoc ky thuat viec chdn doan benh VTC khong con mdy kho khan, cac ky thuat thuang dugc ap dung la dinh lugng men tuy trong mau va nuac tieu. Sieu am tuy la mot ky thuat dugc pho biln rong rai, de sir dung, cho kit qua nhanh va chinh
'Benh vien Dai hoc Y HP. ^' Benh vien Viet Tiep HP
xiic. Chup CT scanner co gia tri kVn trong ciic the V rC CO biC'ii chimg nhat h'l liii-ii ciiirng hoai tir. () benh vien Dai hoc \ Ilai Phiing, so benh nhan bi \' I (' N'iio diim tri ngiiy cirng tang. Chinh \i \a\ chiing toi diil \an dc nghicMi ciru dc tai niu nham muc dich:
Md td trieu chirng lam sdng vd xet nghiem benh viem tuy cap tai benh vien Dai hoc y Hdi Phdns.
II. OOI TUONG VA PHUONG PHAP NGHIEN CUU 2.1. Doi tu'9'ng nghien cii'u
76 benh nhan (BN) dugc chan doan theo non, bung chuirng hai.
Xct nghiem Amylase mau va nu6(
lii-u: moi BN dugc lam 3 liin:
I Lan 1: liiin khi BN mai vao vien + l i n 2: khi diiiu tri dugc 3 ngay
+ Lan 3: tluriyng sau 6 ngiiy dieu tri hoac truoc khi xuat \ ien.
Neu iiim \in niiy ket qua Amylase tro \\
binh thuiwg thi lan sau khong lam nira. Lay miiu vii nuac tieu dc dinh lugng Amylase vao ciing mgt giir trong ngay.
Ticu chuan chan doan VTC:
+ Lam siing: Dau biing dot ngot kem
\JC tai benh \icn Dai hgc Y lliii Phi^ng tir thang 1/2010 din thang X'2011.
2.2. Phuong phap nghien ciiu Phuang phap nghien ciru mo ta
- Moi BN dugc hoi, tham kham va theo doi bang mau benh an rieng.
+ Xct nghiem: Amylase mau > 660U1/L;
Amyla.sc nieu > 1320UrL
+ Sieu iim co hinh anh VTC: tuy to, nhu mo khong diiu, co 6 giam am. co dich quanh tuy.
BN dugc chiin doan VTC khi c6 cac trieu chimg lam sang \ a \m\lase mau hoac nieu tang hoac hinh anh \' rC tren sieu am.
I. KET QUA
Bang 1: Tuoi
Do tuoi N
%
<20 2 2,63
20-29 8 10,52
30-39 9 11,84
40-49 23 30,26
50-59 21 27,63
60-69 7 9,21
>70 6 7,89
Cong 76 100
Nhan xet: Bang 1 cho thay nhom tuoi mac benh cao tir 30-59 chiem 69,73° o. cao nhat tii 40-49 chiem 30,26%, it gap nhat lira tuoi duai 20 chiem 2.63" o.
Bang 2: Giai
Gidi N
% P
Nam 37 48,68
Nu' 39 51,31
>0,05
Tonq 76 100
Nhan xet: Bang 2 cho thay c6 37 BN nam chiem 48,68%, 39 BN nir chiem 51,31%- Bang 3: Dia chi
Dia chi N
% P
NQI thanh 41 53,94
> 0
Ngoai thanh 35 46,06 ,05
Tonq 76 100
Nhan xet: co 41 BN ngi thanh chiem 53,94%, 35 BN ngoai thanh chiem 46,06%)
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
Bang 4: Thai gian tir khi bi benh din khi nhap vien
Npi Thanh
Ngoai thanh Cong
% N
%
%
Ngay Jau 24 58,53
19 54,82
43 56,57
>0.05
Ngay thiir 2 15 36,58
11 31.42
26 34,21
>0.05
> 2 ngay
4,87
14,28
^ 1 1
>0.05
Tong 41 100
35 100
76 100
>0.05
Nhan xet: ngay dhu nhap \ ien noi thanh co 58.53% BN nhap vien, ngoai thanh co 54,82%
BN nhap vien. Qua 2 ngay ngi thanh co 41,47% BN nhap vien, ngoai thanh co 45,18% BN nhap vien.
Bang 5: Ly do \ao \ ien
N
%
Dau bung 69 90,78
Non 7 9,28
Tong 76 100
Nhan xet: Trong 193 BN VTC, 89.64% BN \ao vien vi dau bung, 20 % BN vao vien vi non.
N
%
B a n g 6: T r i e u c h u n g ca nang Dau bung
Dau thu'dng vj
56 73,68
Dau tren ron
9 11,84
Dau ha Su'dn phai
7 9,21
Lan len ngiTc
3 3,94
Lan sau Lu'ng
11 14,47
Dau mang su'dn phai
2 2,63
Non
17 22,36
Sot
5 6,57
Nhan xet: co 73,68% BN dau thugng vj, 14,17% dau lan ra sau lung, 9 BN dau tren ron chiem 11,84% va 3 BN dau lan len nguc chiem 9,34%). Trieu chung non co 17 BN chiem 22,36%.
Bang 7: Trieu chung thuc the
n
%
Bung chudng
72 94,73
Vang da vang mat
3 3,94
Gan To
1 1,31
Tui mat to
1 1,31
Tran djch MF
1 1,31
Tran djch MB
2 2,62
Nhan xet: co 72 BN chiem 94,13% bung chuang. Cac trieu chung khac gap vai ti le khong dang kh tir 1,31 % dhn 3,94%.
Bang 8: So lugng bach cau
N
%
< 9 g / l 8 10,52
9 - < 1 6 g / l 43 56,57
^16g/l 25 32,89
Tong 76 100
Nhan xet: s6 BN co bach cSu tang > 16g/l co 25 BN chilm 32,89 %>, tir 9 den < 16 g/l co
*3 BN chiem 56,57%.
Bang 9: Amylase niiiu, nieu lan 1
N
%
< 220U/I 2 3,94
Amylase mau n= 76
^220:<660u/l
19 25,nn Nhan xct: co S^ RN chiem 72.W-, cc
660U/I
Amylase nieu n = 7 6
< 1320U/I 13 17,10_
S1320U/I 63 82,89
CO Amylase mau tiing cao > 660u/, 63 BN chiem S2.8W'o CO Ani> lasc nieu tang cao >1320u/l
Bang 10: Amylase mau, niCuiJan 2, lan 3
Lan 2
Lan 3
N
% N
%
< 660U/I 26 52,72
23 88,46
Amylase mau _ .•660U/I
29 47^28
11,54
Amylase nieu
< 1320U/I 29 46,03
21 61,76
> 1320U/I 34 53,97
13 38,24
Nhan xet: Chiing toi lam xct nghicMii lim 2 viio thir 3 vii lim 3 \ iio ngay thir 6 tha): Phan Ion Amylase mau \a nieu deu giam sau 3 ngiiy dieu tri.
n
%
Gluose
<7mmol/l 57 75,00
n = 7 6
>7mmol/l 19 25,00
B a n g 1 1 : Cac xet n g h i e m sinh hoa LDH n=52
<350u/l 29 55,76
>350u/l 23 44,24
GOT n=75
<250u/l 61 81,33
>250u/i 14 18,67
Tryglycerld n=70
<1.3mmol/l 53
>1.3mmol/l 17
75,71 24,29
Nhan xet: Bang 11 cho thiiy glucose mau tang >7.8mmol 1 co 19 BN chiem 25°o. LDH>
350uyi CO 23 BN chiem 44.24°/o. Triglycerit > 1.3mmol/l co 17 BN chiem 24.29%.
n
%
Binh Thu'dng
11 14,47
B a n g 12: Sieu am tuy Benh ly n = 5 1
Tuy to 32 42,10
Nhu mo Khong deu
46 60,52
6 giam am
26 34,21
Dich quanh tuy
19 25,00
TDMF 11 14,47
TDMB 20 26,31
Nhan xet: co 51 BN chiem 61,10% c6 hinh anh ton thugng tuv tren sieu am, trong do chu yeu la tuy to, nhu mo tuy khong dcu (42,10% \a 60.52" o).
IV. BAN LUAN
4.1. Tuoi, gioi va dja chi
Tuoi: Ket qua bang 1 cho thSy: so BN mac benh tap trung chii yeu a lira tuoi tir 30 d6n 59 chiam 69,73%, cao nhit tir 40-49 tu6i chiem 30,26%. Ket qua nghien cim ciia chung toi phii hgp vai ket qua nghien cuu
ciia Le Van Thieu, Pham Van Nhien [4], Ton That Bach [1].
Giai: Bang 2 cho thSy ti le nam/nft la 0.94/1, khac biet khong co y nghia thong ke p
>0.05. Nhu vay gioi khong co anh huong tod VTC.
Dja chi: Bang 3 cho thiy ti le BN noi thanh/BN ngoai thanh la 1.17/1, trong khi do ti le so dan ngi thanh so vai s6 dan ngoai
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
thanh bang V2. Sir khac biet khong c6 y nghTa rang VTC trieu chiing lam sang quan trong thong ke vai p > 0.05. Theo chung toi co le va thuang co la dau bung viing thugng vj, do benh vien a ngi thanh cho nen thuan Igi chuang bung [1] 12].
ban cho nguai dan s6ng a ngi thanh, mat 4.3. Trieu chu-ng xet nghiem
khac nguai dan ngi thanh co dai song cao Xet nghiem bach cau trong mau: Bang han ngoai thanh va c6 nhiSu dihu kien thuan 8 cho thay co tai 89,46% BN co bach c4u Igi to chuc an, uong rugu bia nhieu deu la tang > 9g/l. Theo tieu chuan ciia Ransons, nhimg nguyen nhan hay gap ga> VTC. nhung BN co so bach cau >16g/l thuoc nhom
Doi chieu dia chi vai thc^i gian tii- khi bi nhung BN dir bao de tra thanh VTC nang, benh den khi nhap vien (bang 4) cho thin: theo nghien cim cua chiing toi so BN nay co ngay dau nhap vien ngi thanh co 58.53%) BN 25 chiem 32.89%. Tuy nhii-n theo doi qua nhap vien, ngoai thanh co 54.82% BN nhap trinh dien bien dieu tri, so BN nay co trieu vien. Qua 2 ngay ngi thanh co 41.47% BN chirng deu giam dan va khoi hoan toan.
nhap vien, ngoai thanh co 45,18%) BN nhap Xct nghiem amylase mau va nieu: moi vien. Su khac biet nay khong co y nghTa BN khi \ iio vien sau khi tham kham neu nghi thdng ke. Nhu vay tinh dhn thai gian tii" khi nga la VTC chiing toi cho dinh lugng ngay bi benh d^n khi nhap vien thi cho a it anh Amylase mau va nieu. Ket qua cho thay co huong dhn \iec BN phai di kham benh. Bihu 55 BN chi6m 72,36% co Amylase mau tang nay cho th4y benh VTC xay ra thuang dot cao > 660u/, 63BN chilm 82,89%) co nggt, trieu chung cip tinh, diJ doi lam BN Amylase nieu tang cao >1320u/l. Ket qua phai di kham benh ngay. nghien cuu cua chiing toi phii hgp vai ket 4.2. Trieu chirng lam sang qua nghien cuu ciia Ton Thdt Bach [1]. Bang - Trong nghien cuu ciia chung toi thay 10 cho thay diln bien sau 3 ngay dieu tri chi CO hai nguyen nhan khiln BN VTC phai trong s6 55 BN co Amylase mau tang a Mn vao vien la dau bung va non trong do dau xet nghiem dau tien. Amylase tang a mau bung la 90,78%), non la 9,22%. Dihu nay cho chi con 26 BN chiSm 47,28%, a nuac tihu thay trieu chung dau bung trong VTC thuang con 34 BN chilm ti le 53,97%. Xet nghiem la khai phat dot nggt, du doi lam cho BN lo Amylase tang a mau lan 3 chi con 3 BN ling va phai di kham benh. chilm ti le 3,94% tdng s6 BN VTC va
Vi tri va huong lan cua dau bung trong 11,54% BN dugc xet nghiem lan 3 va a nuac 'VTC: CO 73,68% BN dau thugng vi, 14,17% tilu chi con 13 BN chilm 17,10% tdng s6 :dau lan ra sau lung, 9 BN dau tren r6n chilm BN VTC va chilm 38,24% s6 BN dugc xet
11,84% va 3 BN dau lan len nguc chilm nghiem lan 3. Binh thuang Amylase nieu gap 9,34%. Trieu chung non col 7 BN chilm 22,36%). 2 ISn Amylase mau. Trong khi do Amylase
Khi tham kham VTC chung toi thiy nieu tang manh han va keo dai han. Kit qua gap chii ylu la BN co chuang bung chilm nghien cim ciia chiing toi phii hgp voi ket 94,73%). Cac trieu chimg khac gap vai ti le qua nghien cim cua Le Van Thieu, Pham Van 'khong dang k l (gan to, tui mat to, tran djch Nhien [4]. Nhu vay theo chung toi ngoai viec W n g phoi, tran dich mang bung...). Kit qua xac dinh Amylase mau va nieu tai thcyi diem
• aghien cuu cua chung toi phu hgp vai nhieii nao do con phai danh gia ti le giira Amylase
"ilt qua nghien cuu cua nhilu tac gia cho mau va nieu vi dien biln cua no theo thai
I',
!; w
gian, CO nhu \ay mai su dung het vii hgp ly gia tri cua Am\lasc trong chiin doiin VTC
- Ngoai ciic xct nghiem ca biin di- chan doan, theo doi ket qua diim trj vii lii-n lugng, mgt sd gia tri xct nghiem sinh hoii miiu khac cung gdp phiin danh gia ticn lugng va di,r phdng dien biCMi nang trong VIC. Bang 11 cho thin glucose mau lang >7.8mmol/l cd 19 BN chilm 25",.. LDll > 350u/l co 23 BN chiem 44.24"o, Triglycerit > 1.3mmol/l cd 17 BN chiem 24,29"o. Nhu viiy neu theo ticu chuan Ransons thi sd BN V IC trd thiinh
\ iem tuy nang chiem tdi gan 50%. Tuy nhien qua theo ddi dien bien va ket qua dieu tri.
khdng BN nao dien bien nSng ne ma dcu khdi dan cac trieu chirng va xuat vien dugc.
Hinh anh sieu am tuy: Bang 12 cd 51 BN chiem 67.10% cd hinh anh tdn thugng tuy tren sieu am, trong dd chii yeu la tuy to, nhu md tuy khdng diu (42,10%) va 60,52%)).
Dau hieu sieu am quan trong va cd gia trj chan doan la dich quanh tuy chilm 25%. Kit qua cua chung tdi phii hgp vai ket qua nghien cuu cua Tdn That Bach [1]. Theo chung tdi, sieu am la ky thuat cd gia tri de chan doan VTC nhat la the nang cd bien chung. Mat khac day la ky thuat rat phd bien, re tien rat phii hgp vdi dieu kien hien nay cua Viet Nam.
V. KET LUAN
1. Trieu chiing lam sang
90,78% benh nhan vao vien vi ly do dau bung
- 73,68%) benh nhan cd dau a \'i tri thugng vi
22,36%) cd non
94,73%) benh nhan cd bung chuang hai 2. Trieu chiing xet nghiem
Amylase: trong nga)' d4u nhap vien amylase mau tang > 660u/l cd a 72,36%)
benh nhiin, trong nuac tieu tang > 1320u/l i (V 82,89%) benh nhan sau dd giam dan, v;
ngiiy thir 6 chi cdn 3 benh nhan (3.94%)) tai amylase mau, 13 bcMih nhan (17,10%o) tar amylase nieu.
Sicu am tuy: cd 67,10%) benh nhanc tdn thirang tuy tren sieu am trong dd chii ye la tuy to (42,10%)), nhu md tuy khdng d^
(60,52%).
BachcAu> 16g/lcd 32.89%
Sinh hoii miiu: glucose mau tan
>7.8mmol/l cd 19 BN chiem 25%, LDH:
350u/l cd 23 BN chiem 44,24%, Triglycer
> I.3mmol/l cd 17 BN chiem 24,29%.
TAI LIEU THAM K H A O
1. Ton That Bach >;« cs (2002), "Mot s6 nhg, .xet ket qua dieu tri viem tuy cap hoai t\
khdng do nguyen nhdn co hoc tai khoa cq ciru bung BV.l'iel Dire Ngoai khoa so 2
19-23.
2. Pham Thj Thu Ho (2003), ChAn doan v dieu trj Viem tuy cap. Bai giang sau dai hpc, 3. Vu Thj Tuyet Le, Hoang Trong Churffni
(1995),".\7/<://7 .xet ve vi'u to dich te. nguyei nhdn vd yeu td ngng h^nh viem tuy cap dih tri tai b('nh vien Hue trong 3 nam qua",'Ho khoa sd/1995.24-27
4. Le \ an Thieu, Pham \ an Nhien (2010)
"Dgc diem Idm .'<dng vd .xet nghiem benl viem tuy cdp tai khoa ndi tieu hod b^nh biei Hint Sglii I let Tiep Ihu Phdng" Tap chi ^ hoc th^rc hanh, so 725 + 726, tr: 382-386.
5. Beat Gloor, MD.et (2001), ' Pancreatic infection in severe pancreatitis , Arcl Surgery, Vol 136, pp: 592-596.
6. Gullo et (2002), "Acute Pancreatic inp European Country: etiology anh mortality/
Pancrea, Record 2of 22- Medline on CI 2002/01 -2002/07.
